Transcript Document

Healthcare and Substance Use Services
… a national perspective
Prevention and Recovery Conference 2014
November 6, 2014
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www.TheNationalCouncil.org
Thank you!
This morning…
•Healthcare Environment
•Implications for Specialty
Addictions and Mental
Health
•Practice and Public policy
agenda
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2250 Behavioral Health
Organizations in 50 States
750,000 staff serving 8
million adults,
children, and families
with mental illness
and substance use
disorders…
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Members are community
problem solvers…
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Caring for complex, costly adults & children…
Socially
vulnerable
patients
(income, language,
race/ethnicity,
health disparities)
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Clinically
vulnerable
patients
(complex, difficult
healthcare needs)
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Change: Not just your state or organization
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And it’s not just our sector…
Seminar on Surviving Insurance
Exchange Challenges
Aetna, AmeriCare, Blue Cross,
Lilly, Magellan…
•Maintain profits in environment
of health reform & budget
uncertainty
•Capture your share of the soon
to expand Medicaid market
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Best of times but complex times as healthcare
change is profound and fast paced…
Parity and the ACA
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Best of times…recognizing impact of
co-morbidities
• ¼ of all hospital
stays comorbid
mental or
substance use
disorder
• Untreated comorbid conditions
generate higher
overall costs
www.thenationalcouncil.org
Best of Times: Opportunity to
Improve Lives…
Addiction ravages communities,
families, and individuals.
> Leading cause of preventable
death in the U.S.
> Since 1980, 3.3 million people
in U.S. died of addictions, while
600,000 people died of AIDS
Contact: [email protected]
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Best of times: Increasing
awareness and support…
• Addiction as chronic medical
disorder that responds to treatment
(McLellan and Kleber, JAMA 2000
• Block Grant
• Legislation
• Media
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Inconvenient Treatment Truths:
• #1: We have failed to bend the curve for morbidity
and mortality from addictions or mental illness.
(Health Homes)
•#2: More people getting more of today’s Rx but
outcomes are not any better
•#3: In spite of progress, we still don’t know enough
to ensure prevention, recovery, or cure
•#4: Science is Slow. But we need to use what we
already know to correct course!
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Operating struggles as we move
from silo to equality…
> Managed” care (carve outs/ in) – Commercial business
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models
Relationships with physical health – Build it or buy it
Knowing costs/cost-cutting techniques – Standardize care
Resources – Financing new service lines, facility
improvements, HIT, workforce
Collaboration – different language with new players
Competition – for consumers and payers
Increased compliance scrutiny
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In these complex times…
National Council and
SAAS Merger…
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Understand
Environment…
• Appetite for
Experimentation
• Competition driving
Monopoly Economy
• Demand for Impact
enabled by technology
revolution
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Reform is all about Service Redesign…
>Reduce institutional care
>Deliver health services within an integrated and connected
delivery system
>Identify and manage “high need/cost” individuals
Payers focused on models that
integrate medical care, behavioral
health and social supports; and take
responsibility for a population…
> Integrated Care
> Healthcare Homes
> Accountable Care
Organizations
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States…
Increasing Medicaid coverage/spending
•Increase about 13.2% across the country in FY15
from 18% in 28 expansion states to 5% 18% in 23
states not expanding
•Medicaid directors - delivery system
reforms
•Rapid shift to managed care — carve out and
integrated
Kaiser Family Foundation’s
Commission on Medicaid and the • “Any willing provider”
Uninsured and State Medicaid
•Medicaid health homes; patient-centered medical
Directors
homes; integrating care; and financing for the dual
eligible beneficiaries.
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National Council and Bi-directional
Integration…
Sustainability***
>Learning Communities – FQHC/SUD
>SAMHSA-HRSA Center for Integrated Health***
>NY State Geriatric Technical Assistance Center
>Ohio Training & Technical Assistance Center
>CDC
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Service Redesign to Payment
Redesign …
Episodic Cost Accountability
Total Cost Accountability
RISK
Traditional
Fee-for-Service
Minimal
Shared
Pay-forSavings
Performance
Bundled
Payment
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Shared
Savings
Savings Potential for Health Plans and Customers
Partial Full
Risk Risk
Substantial
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Competition and consolidation…
Large legacy hospital healthcare
systems in acquisition mode to gain
market share
Behavioral health embedded in
primary care; or partnering with
hospitals/medical homes to provide
care to people with complex
conditions
New players economy of scale and
standardization – mergers; private
equity
Monopoly Economy
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Technology… in our Hands, Homes
or Offices
eHealth Revolution
Big Data
Cut costs by 197 billion over
next 25 years
Demand for Impact…
World Class Customer Service
Branding - think
Nordstrom, Starbucks,
Apple, and Amazon Prime
• Accessible
• Provides a personal touch
• Resolves problems well.
Outcomes…
> Transparent
> Standardized
> Measured
> Benchmarks
Experimentation, Competition,
Demand for Impact …
• Free standing and Embedded Practice Units —
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Responsible for disease, related conditions, and
circumstances
Patient Specific Outcomes-based Care — Measure full
set of outcomes and costs for each patient
Bundled Payments — preferred provider for chronic
conditions
Geographical Expansion — Affiliations, mergers, and
acquisitions = volume
Standardize Across Sites — Determine scope of service
and standardize care across sites
Enabling Technology Platform — Enable measurement;
new reimbursement approaches; tie delivery systems
together
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The best way to
manage change is
to lead it.
Our Quality Initiatives…
Improving the operations and administrative backbone to
support clinical practices
Improving patient outcomes through implementation of
evidence-based and promising practices
Developing future healthcare leaders
•25-30 initiatives
•Varied funding sources
•Range in size: 5 organizations – hundreds
•Primarily only available to members, with some exceptions
•1100 organizations
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Behavioral Health Center of Excellence
• known by the entire community as a great
place to get care and a great place to work
World Class Customer Service: “Kind words can be short and
easy to speak, but their echoes are truly endless.”
Excellent Outcomes: “Take responsibility for making sure I
receive the best possible health care.”
Easy Access: “Be there when I need you.”
Comprehensive Care: “Provide or help me get the health care
and services I need.”
Excellent Value: “We are accountable for both the cost and
quality of care.”
Our Policy Agenda…
2% of Bills
become
Laws
Just over half of bills proposed
saw some form of committee
consideration; however, most of
these actions consisted of proforma referrals to relevant
subcommittees
Only 7% of bills introduced
made it to the floor of either
the House or Senate, a
marker that the bill enjoyed
serious deliberation
Analysis
• The vast majority of bills introduced in the 112th Congress failed to become law, and most never even came close
• Only 2% of bills introduced in the 112th Congress were ultimately enacted
Sources: Library of Congress Legislative Information System; Congressional Research Service.
Mental Health First Aid: $15 million in FY 2014
MHFA Act (S.153/H.R. 274)*
2014 Appropriations
> SAMHSA: +$144M
> Substance Abuse Prevention & Treatment Block
Grant: +$19M
> Mental Health Block Grant: +$24 million
> Primary/Behavioral Health Integration: +$19M
Addictions Legislation
Breaking Addiction Act
Reps. Marcia Fudge and Tim
Ryan of Ohio, authors of
H.R. 5136.
 H.R. 5136 allows Medicaid for
residential substance use
treatment, including detox
 8-10 states participate in $300
million demonstration program.
 15 million Medicaid beneficiaries
could gain access to treatment
 Demonstration is the first step
toward broader evaluation of
Medicaid payment policy.
Comprehensive Addiction and
Recovery Act
 Resources for states and local
governments combat addiction.
 Expands prevention and
educational; disposal sites for
unwanted prescriptions; naloxone
to law enforcement
Senators Sheldon Whitehouse  Launches evidence-based opioid
(D-RI) and Rob Portman (R-OH),
and heroin treatment program
authors of S. 2839
 Strengthens prescription drug
monitoring programs.
Social Justice Agenda
> Ensure ADA, Rehabilitation Act, Fair Housing Act, and
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other laws protecting against discrimination are
enforced.
Eliminate or reduce barriers to SSI/SSDI
Ensure people with drug and/or criminal histories
receive food and other assistance they need.
Provide voting rights to individuals no longer
incarcerated.
Reduce barriers to people with criminal records or
histories of substanceuse and their families living
together in public and federally assisted housing.
Agenda: building capacity
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“If it was any other disease, we’d
be marching on the streets!”
If addiction is a chronic medical condition
what’s our Medicaid service continuum?
•Residential
•Housing
•Integration; Care Coordination
•Medications
•Peer Services; Outreach
•Work Supports; Family Education
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The greatest danger in
times of turbulence is not
the turbulence. It is to act
with yesterday’s logic.
Peter Drucker
Contact: [email protected]
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